Hamilton Naki


Hamilton Naki, an unrecognised surgical pioneer, died on May 29th, aged 78


ON DECEMBER 3rd, 1967, the body of a young woman was brought to
Hamilton Naki for dissection. She had been knocked down by a car as
she went to buy a cake on a street in Cape Town, in South Africa. Her
head injuries were so severe that she had been pronounced brain-dead
at the hospital, but her heart, uninjured, had gone on furiously
pumping.

  Mr Naki was not meant to touch this body. The young woman, Denise
Darvall, was white, and he was black. The rules of the hospital, and
indeed the apartheid laws of the land, forbade him to enter a white
operating theatre, cut white flesh, or have dealings with white
blood. For Mr Naki, however, the Groote Schuur hospital had made a
secret exception. This black man, with his steady, dexterous hands
and razor-sharp mind, was simply too good at the delicate, bloody
work of organ transplantation. The chief transplant surgeon, the
young, handsome, famously temperamental Christiaan Barnard, had asked
to have him on his team. So the hospital had agreed, saying, as Mr
Naki remembered, "Look, we are allowing you to do this, but you must
know that you are black and that's the blood of the white. Nobody
must know what you are doing."

Memoirs of surgery


  Nobody, indeed, knew. On that December day, in one part of the
operating suite, Barnard in a blaze of publicity prepared Louis
Washkansky, the world's first recipient of a transplanted human
heart. Fifteen metres away, behind a glass panel, Mr Naki's skilled
black hands plucked the white heart from the white corpse and, for
hours, hosed every trace of blood from it, replacing it with
Washkansky's. The heart, set pumping again with electrodes, was
passed to the other side of the screen, and Mr Barnard became,
overnight, the most celebrated doctor in the world.

  In some of the post-operation photographs Mr Naki inadvertently
appeared, smiling broadly in his white coat, at Barnard's side. He
was a cleaner, the hospital explained, or a gardener. Hospital
records listed him that way, though his pay, a few hundred dollars a
month, was actually that of a senior lab technician. It was the most
they could give, officials later explained, to someone who had no
diploma.

  There had never been any question of diplomas. Mr Naki, born in the
village of Ngcangane in the windswept Eastern Cape, had been pulled
out of school at 14, when his family could no longer afford it. His
life seemed likely to be cattle-herding, barefoot and in sheepskins,
like many of his contemporaries. Instead, he hitch-hiked to Cape Town
to find work, and managed to land a job tending lawns and rolling
tennis courts at the University of Cape Town Medical School.

  A black-even one as clever as he was, and as immaculately dressed,
in a clean shirt, tie and Homburg hat even to work in the
gardens-could not expect to get much further. But a lucky break came
when, in 1954, the head of the animal research lab at the Medical
School asked him for help. Robert Goetz needed a strong young man to
hold down a giraffe while he dissected its neck to see why giraffes
did not faint when they drank. Mr Naki coped admirably, and was taken
on: at first to clean cages, then to hold and anaesthetise the
animals, then to operate on them.

  Stealing with his eyes

The lab was busy, with constant transplant operations on pigs and
dogs to train doctors, eventually, for work on humans. Mr Naki never
learned the techniques formally; as he put it, "I stole with my
eyes". But he became an expert at liver transplants, far trickier
than heart transplants, and was soon teaching others. Over 40 years
he instructed several thousand trainee surgeons, several of whom
moved on to become heads of departments. Barnard admitted-though not
until 2001, just before he died-that Mr Naki was probably technically
better than he was, and certainly defter at stitching up afterwards.

  Unsung, though not unappreciated, Mr Naki continued to work at the
Medical School until 1991. When he retired, he drew a gardener's
pension: 760 rand, or about $275, a month. He exploited his medical
contacts to raise funds for a rural school and a mobile clinic in the
Eastern Cape, but never thought of money for himself. As a result, he
could pay for only one of his five children to stay to the end of
high school. Recognition, with the National Order of Mapungubwe and
an honorary degree in medicine from the University of Cape Town, came
only a few years before his death, and long after South Africa's
return to black rule.

  He took it well. Bitterness was not in his nature, and he had had
years of training to accept his life as apartheid had made it. On
that December day in 1967, for example, as Barnard played host to the
world's adoring press, Mr Naki, as usual, caught the bus home.
Strikes, riots and road blocks often delayed it in those days. When
it came, it carried him-in his carefully pressed suit, with his
well-shined shoes-to his one-room shack in the township of Langa.
Because he was sending most of his pay to his wife and family, left
behind in Transkei, he could not afford electricity or running water.
But he would always buy a daily newspaper; and there, the next day,
he could read in banner headlines of what he had done, secretly, with
his black hands, with a white heart.

The Economist, June 9